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Some of the youngest learners need mental health treatment
By Margaret Ramirez

A rare dose of treatment for preschoolers traumatized by violence

CHICAGO –– When 3-year-old Julian started throwing tantrums in preschool, his teachers were unsure how to handle him. His screaming, inconsolable crying and violent outbursts soon escalated to the point where he threw a chair at a teacher. He was subsequently kicked out of the childcare program.

His mother, Angelica Pabon, knew the reason for Julian’s anger and aggression: A few months earlier, the young boy had witnessed his father being shot to death. To recover from the traumatic experience, Julian needed a preschool capable of working through his emotional problems while supporting his academic growth.

After a referral from a social worker, Pabon enrolled Julian at Erie Neighborhood House, one of the few early childhood programs in Chicago offering educational and mental health services for young children. There, he received close attention from teachers in a therapeutic classroom to control his anger. He also attended one-on-one “play therapy” sessions with a psychologist. That was six years ago. Today, Julian’s mother says, he is a 9-year-old doing well in fourth grade at a Chicago public school.

“If I hadn’t come to this program, they would have placed Julian in special education, not because that’s where his mind is, but because of the way he was acting,” said Pabon, 28, a single mother of four who works in a hospital insurance department.

Julian’s case illustrates a larger, more complex issue simmering inside many of the nation’s early childhood centers that serve children impacted by violence and poverty. According to a recent nationally representative survey, 13 percent of infants a year-old and younger and 44 percent of all 2- to 5-year-olds were assault victims in the prior year. Eight percent of infants and 14 percent of 2-to 5-year-olds had also witnessed violence. Other studies have had similar findings.

Most assaults on young children did not involve a weapon or result in injury, and siblings and playmates were the most common perpetrators. Still, early education experts say, any experience of violence can be traumatic. Yet few preschools have mental health professionals on staff, leaving many children in danger of falling through the cracks. Early investment would save money as well as heartache later on, experts say.

“If we put that money at the front end, we will spend less on special education classes for behavior disorder, we will spend less on adolescent substance abuse, we will spend less on gang violence, we will spend less on the juvenile criminal justice system,” said Margret Nickels, a clinical psychologist at Chicago’s Erikson Institute who is known as an authority on early childhood mental health.

In West Town, the largely Latino neighborhood where Erie’s early childhood program is located, many young children have seen violence in their homes or communities. Others show anxiety due to family hardships involving poverty, unemployment or immigration status.

On weekday mornings, mothers clutching their young children’s small hands steadily file into the Erie Community Center for drop-off. Erie Community Center is home for the early childhood program and is one of three Chicago locations managed by Erie Neighborhood House. The sprawling three-story brick building on West Superior Street houses a dozen classrooms for more than 170 children. Five classrooms serve 2- and 3-year-olds and the remainder for 3- to 5-year-olds.

To offer mental health services, the program spends $160,000 annually for a full-time psychologist and social worker who provide treatment for about 70 children each year. But Erie also relies heavily on unpaid graduate students, and officials estimate the true value of their services is more than double the current budget, which is supported by federal, state and private funds.

Erie psychologist Elizabeth Yelen, who has treated hundreds of children in her 16-year career, said traumatized young learners who don’t get help in the early years are in danger of long-term academic difficulties that are far more expensive.

“A lot of them go to school with less information because their behavior impacts their learning,” she said. “They’re already feeling bad because they might have failed in preschool, which is hard to fathom, but it happens.”

She said children do better in school when they come out of preschool feeling safe and successful and knowing how to interact with their peers.

The long-term impact of violence on a young mind is real, experts say. And studies show that experiencing violence in early childhood can lead to lasting physical, mental and emotional harm, whether the child is a direct victim or a witness. Young children who are exposed to violence are more likely to suffer from attachment problems, anxiety and depression, leading to aggression and behavioral issues.

Exposure to violence can also lead to various health problems and make children more likely to be involved in the juvenile justice system. Even community violence that children do not directly witness has been shown to hurt their ability to pay attention as well as their cognitive performance.

According to experts, treating such children requires close collaboration between teachers, social workers and parents.

In the case of Julian, whose last name is being withheld for his protection, the boy was showing a range of intense emotions, from anger and aggression to profound sadness and neediness. He was literally breaking down, Yelen said. The beginning of his treatment, and in some ways the key to his later success, started with a simple act: A teacher held him.

“The teacher who was in that classroom at the time held him a lot,” Yelen said. “He needed to be held. He needed to be nurtured. And that’s what we were doing.”

For children like Julian who have witnessed murder, “how much scarier can it get?” she continued. “They are completely flooded with anxiety. A lot of our job is helping them to feel safe. And if you feel safe, you can learn.”

Julian’s mother also received guidance at Erie on how to work through Julian’s emotional problems at home. Pabon recalled how after his father’s death, her son would constantly ask questions. Before therapy, the young mother would become exasperated and tell him to “stop asking questions.”

“He would always ask, ‘What are we going to do?’ and it’s because he’s afraid, he’s scared, he doesn’t know what’s going to happen,” she said. “So now I know that I have to explain everything: ‘First, we’re going to do this, then we’re going to do that.’”

Although Julian no longer receives services at Erie, two of his younger siblings, 5-year-old Anjel and 3-year-old Liliana, are currently enrolled there.

Nickels said there is a growing need for psychologists and social workers at preschools to support teachers in working with children’s emotional needs.

In response, the Erikson Institute’s Center for Children and Families last year opened a neighborhood-based therapy office in the Austin neighborhood, an underserved Chicago community with a high rate of violence. Nickels, the center’s director, said several of the first children who came for therapy were 3-year-olds who had been expelled from preschool or childcare centers by teachers with no knowledge of how to handle traumatized children.

While the link between trauma and brain development has been well documented, Nickels said she still encounters ignorance on the topic from childcare workers, preschool teachers and even principals who wrongly believe that young children don’t understand what is happening and are not impacted.

“Shouting, watching your parent get hit, these are emotional and physiological experiences that even infants perceive and trigger intense stress reactions,” Nickels said.

“These intense stress reactions are carried by brain chemistry that have, in turn, a very damaging impact on brain development. The substances that are being released during stress responses can either halt or reverse important brain developmental processes. It can literally destroy very vital connections that are formed as the brain develops during those first few years of life.”

Early recognition and treatment of emotional problems in young children would likely decrease disciplinary action and reduce the number of children misdiagnosed as special education students, she said: “If we understand that this kind of exposure to stress literally disables children in many ways that are needed for school success…then we understand why they’re not listening. It’s because they can’t. They’re not aggressive because they’re just bad. It’s because they don’t know what else to do. So it becomes an issue of, ‘What do we need to teach them?’ rather than, ‘Why are they doing this to us?’”

Inside Erie Neighborhood House’s early childhood program, the preschool classrooms appear like most others at first glance, with children stacking blocks and coloring art projects. However, the program is different in several important ways. In addition to a lead teacher, each classroom has three psychology graduate students who assist in assessing each child’s emotional needs. This fall, Erie has a total of 11 psychology graduate students who will likely carry 10 cases each.

During naptime, teachers meet with Yelen and her psychology students to develop plans for emotional growth through play therapy and academic growth in the classroom.

On the building’s lower level, children who need individual attention participate in weekly play therapy sessions with Yelen or one of the graduate students. The cheery therapy rooms are painted in bright colors and stocked with toys, a sand and water play table, and a poster with photos and drawings illustrating various emotions including happy, worried, surprised and sad.

Of the 174 children enrolled at Erie, about 70 receive either play therapy services or psychological evaluations.

Children guide Erie’s process of play therapy and choose what to play, paint, color or say in a 60-minute session. Music is used when appropriate. Therapists observe and interact according to a child’s individual needs. But the overriding goal is to help children feel a sense of safety by developing a therapeutic relationship, Yelen said.

Erie preschool teacher Angelic Santos who has taught young children for 10 years, said the collaboration between teachers and psychologists is crucial to connect educational and emotional goals.

“For a child to be able to focus and learn and understand, they need to be settled emotionally,” she said. “If they are worried about all the other stresses that they have, whether it’s domestic violence or not having enough food at home, if they don’t learn how to cope, they are going to be too distracted. By addressing all those issues, we can help them to focus and even find solace in education and going to school.”

Though much attention focuses on traumatized children who display anger and aggression, others show more subtle behavioral changes that translate into a quiet cry for help.

Two years ago, Ana Perez recalled how a domestic violence incident caused her then-3-year-old daughter, Angie to change dramatically from playful and outgoing to detached and withdrawn.

Angie became a perfectionist, so obsessed with clothes and her appearance that she would cry if she didn’t like how she looked. Yelen said it is common for kids to manifest their internal struggles with a fixation on external appearance.

After two years of therapy at Erie along with family therapy, Angie, now 5 and in kindergarten, has gained self-confidence and become more engaged and excited about school, said Perez, 38, a petite, soft-spoken, mother of four working as an office assistant for a furniture company.

In play therapy, at Erie, “they’re able to be free in what they want to say because Mom is not there,” Perez said. “Now, Angie is very blunt, and I think that’s because of therapy. And I love that because I’m not scared that she’s holding something in.”